Post written by Mitsuru Nagata, MD, from the Department of Endoscopy, Shonan Fujisawa Tokushukai Hospital, Kanagawa, Japan.

In this report, we present 2 cases of gastric neoplasm treated using S-O clip-assisted endoscopic submucosal dissection (ESD) and discuss the use of the S-O clip for gastric ESD.

The S-O clip (Zeon Medical, Tokyo, Japan) is a novel traction device with a 5-mm spring and a 4-mm nylon loop at its claw. This clip can provide traction in any direction, whereas the direction of traction is limited with a majority of other traction devices. As the S-O clip has been developed as a traction device for colorectal ESD, its use in gastric ESD has not been standardized. However, it is considered useful for gastric ESD. Here, we demonstrate the use of the S-O clip for gastric ESD in both the forward and retroflexed endoscopic positions.

The following problems are associated with the S-O clip during gastric ESD: technical difficulty during attachment and interference with the endoscope in the retroflexed position. We demonstrated a modified S-O clip attachment method to simplify the attachment procedure. Unlike colorectal ESD, as gastric ESD is frequently performed using the endoscope in retroflexed position, especially for the upper or middle thirds of the stomach, we additionally demonstrated the use of the S-O clip in avoiding interference by the endoscope in this position.

It is vital that the traction device provides countertraction. The S-O clip can provide countertraction in both the forward and retroflexed endoscopic positions, unlike many other traction devices. Therefore, the S-O clip has the potential to be the best traction device for gastric ESD.

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